MEDICAL-SURGICAL HESI STUDY QUESTIONS
(SAUNDERS HESI 7TH EDITION) 100%
CORRECT ANSWERS AND RATIONALE.
A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid
ventricular response. Based on this finding, the nurse anticipates assisting the physician
with which treatment?
a. Administer lidocaine, 75 mg intravenous push.
b. Perform synchronized cardioversion.
c. Defibrillate the client as soon as possible.
d. Administer atropine, 0.4 mg intravenous push. - Correct Answer-Perform
synchronized cardioversion
Rationale: With uncontrolled atrial fibrillation, the treatment of choice is synchronized
cardioversion to convert the cardiac rhythm back to normal sinus rhythm. Option A is
a medication used for ventricular dysrhythmias. Option C is not for a client with atrial
fibrillation; it is reserved for clients with life-threatening dysrhythmias, such as
ventricular fibrillation and unstable ventricular tachycardia. Option D is the drug of
choice in symptomatic sinus bradycardia, not atrial fibrillation.
A practical nurse (PN) tells the charge nurse in a long-term facility that she does not
want to be assigned to one particular resident. She reports that the male client keeps
insisting that she is his daughter and begs her to stay in his room. What is the best
managerial decision?
a. Notify the family that the resident will have to be discharged if his behavior does
not improve.
b. Notify administration of the PN's insubordination and need for counseling about
her statements.
c. Ask the PN what she has done to encourage the resident to believe that she is
his daughter.
d. Reassign the PN until the resident can be assessed more completely for reality
orientation. - Correct Answer-Reassign the PN until the resident can be assessed
more completely for reality orientation.
, Rationale: Temporary reassignment is the best option until the resident can be
examined and his medications reviewed. He may have worsening cerebral
dysfunction from an infection or electrolyte imbalance. Option A is not the best
option because the family cannot control the resident's actions. The administration
may need to know about the situation, but not as a case of insubordination. Implying
that the PN is somehow creating the situation is inappropriate until a further
evaluation has been conducted.
Client census is often used to determine staffing needs. Which method of obtaining
census determination for a particular unit provides the best formula for determining
long-range staffing patterns?
A) Midnight census
B) Oncoming shift census
C) Average daily census
D) Hourly census - Correct Answer-Average daily census
Rationale: An average daily census is determined by trend data and takes into
account seasonal and daily fluctuations, so it is the best method for determining
staffing needs. Options A and B provide data at a certain point in time, and that data
could change quickly. It is unrealistic to expect to obtain an hourly census, and such
data would only provide information about a certain point in time.
The nurse is counseling a healthy 30-year-old female client regarding osteoporosis
prevention. Which activity would be most beneficial in achieving the client's goal of
osteoporosis prevention?
A) Cross-country skiing
B) Scuba diving
C) Horseback riding
D) Kayaking - Correct Answer-Cross-country skiing
Rationale: Weight-bearing exercise is an important measure to reduce the risk of
osteoporosis. Of the activities listed, cross-country skiing includes the most weight-
bearing, whereas options B, C, and D involve less.
Which condition should the nurse anticipate as a potential problem in a female client
with a neurogenic bladder?
A) Stress incontinence
B) infection
, C) Painless gross hematuria
D) Peritonitis - Correct Answer-Infection
Rationale: Infection is the major complication resulting from stasis of urine and
subsequent catheterization. Option A is the involuntary loss of urine through an
intact urethra as a result of a sudden increase in intra-abdominal pressure. Option C
is the most common symptom of bladder cancer. Option D is the most common and
serious complication of peritoneal dialysis.
A client is being discharged following radioactive seed implantation for prostate cancer.
What is the most important information that the nurse should provide to this client's
family?
A) Follow exposure precautions.
B) Encourage regular meals.
C) Collect all urine.
D) Avoid touching the client. - Correct Answer-Follow exposure precautions
Rationale: Clients being treated for prostate cancer with radioactive seed implants
should be instructed regarding the amount of time and distance needed to prevent
excessive exposure that would pose a hazard to others. Option B is a good
suggestion to promote adequate nutrition but is not as important as option A. Option
C is unnecessary. Contact with the client is permitted but should be brief to limit
radiation exposure.
In assessing a client with an arteriovenous (AV) shunt who is scheduled for dialysis
today, the nurse notes the absence of a thrill or bruit at the shunt site. What action
should the nurse take?
A) Advise the client that the shunt is intact and ready for dialysis as scheduled.
B) Encourage the client to keep the shunt site elevated above the level of the heart.
C) Notify the healthcare provider of the findings immediately.
D) Flush the site at least once with a heparinized saline solution. - Correct Answer-
Notify the healthcare provider of the findings immediately.
Rationale: Absence of a thrill or bruit indicates that the shunt may be obstructed. The
nurse should notify the healthcare provider so that intervention can be initiated to
restore function of the shunt. Option A is incorrect. Option B will not resolve the
obstruction. An AV shunt is internal and cannot be flushed without access using
special needles.
, The nurse notes that the client's drainage has decreased from 50 to 5 mL/hr 12 hours
after chest tube insertion for hemothorax. What is the best initial action for the nurse to
take?
A) Document this expected decrease in drainage.
B) Clamp the chest tube while assessing for air leaks.
C) Milk the tube to remove any excessive blood clot buildup.
D) Assess for kinks or dependent loops in the tubing. - Correct Answer-Assess for
kinks or dependent loops in the tubing.
Rationale: The least invasive nursing action should be performed first to determine
why the drainage has diminished. Option A is completed after assessing for any
problems causing the decrease in drainage. Option B is no longer considered
standard protocol because the increase in pressure may be harmful to the client.
Option C is an appropriate nursing action after the tube has been assessed for kinks
or dependent loops.
The nurse is assessing a 75-year-old client for symptoms of hyperglycemia. Which
symptom of hyperglycemia is an older adult most likely to exhibit?
A) Polyuria
B) polydipsia
C) Weight loss
D) Infection - Correct Answer-Infection
Rationale: Signs and symptoms of hyperglycemia in older adults may include
fatigue, infection, and evidence of neuropathy (e.g. sensory changes). The nurse
needs to remember that classic signs and symptoms of hyperglycemia, such as
options A, B, and C and polyphagia, may be absent in older adults.
Which abnormal laboratory finding indicates that a client with diabetes needs further
evaluation for diabetic nephropathy?
A) Hypokalemia
B) microalbuminuria
C) Elevated serum lipid levels
D) Ketonuria - Correct Answer-Microalbuminuria
Rationale: Microalbuminuria is the earliest sign of diabetic nephropathy and
indicates the need for follow-up evaluation. Hyperkalemia, not option A, is
associated with end-stage renal disease caused by diabetic nephropathy. Option C
may be elevated in end-stage renal disease. Option D may signal the onset of
diabetic ketoacidosis (DKA).
(SAUNDERS HESI 7TH EDITION) 100%
CORRECT ANSWERS AND RATIONALE.
A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid
ventricular response. Based on this finding, the nurse anticipates assisting the physician
with which treatment?
a. Administer lidocaine, 75 mg intravenous push.
b. Perform synchronized cardioversion.
c. Defibrillate the client as soon as possible.
d. Administer atropine, 0.4 mg intravenous push. - Correct Answer-Perform
synchronized cardioversion
Rationale: With uncontrolled atrial fibrillation, the treatment of choice is synchronized
cardioversion to convert the cardiac rhythm back to normal sinus rhythm. Option A is
a medication used for ventricular dysrhythmias. Option C is not for a client with atrial
fibrillation; it is reserved for clients with life-threatening dysrhythmias, such as
ventricular fibrillation and unstable ventricular tachycardia. Option D is the drug of
choice in symptomatic sinus bradycardia, not atrial fibrillation.
A practical nurse (PN) tells the charge nurse in a long-term facility that she does not
want to be assigned to one particular resident. She reports that the male client keeps
insisting that she is his daughter and begs her to stay in his room. What is the best
managerial decision?
a. Notify the family that the resident will have to be discharged if his behavior does
not improve.
b. Notify administration of the PN's insubordination and need for counseling about
her statements.
c. Ask the PN what she has done to encourage the resident to believe that she is
his daughter.
d. Reassign the PN until the resident can be assessed more completely for reality
orientation. - Correct Answer-Reassign the PN until the resident can be assessed
more completely for reality orientation.
, Rationale: Temporary reassignment is the best option until the resident can be
examined and his medications reviewed. He may have worsening cerebral
dysfunction from an infection or electrolyte imbalance. Option A is not the best
option because the family cannot control the resident's actions. The administration
may need to know about the situation, but not as a case of insubordination. Implying
that the PN is somehow creating the situation is inappropriate until a further
evaluation has been conducted.
Client census is often used to determine staffing needs. Which method of obtaining
census determination for a particular unit provides the best formula for determining
long-range staffing patterns?
A) Midnight census
B) Oncoming shift census
C) Average daily census
D) Hourly census - Correct Answer-Average daily census
Rationale: An average daily census is determined by trend data and takes into
account seasonal and daily fluctuations, so it is the best method for determining
staffing needs. Options A and B provide data at a certain point in time, and that data
could change quickly. It is unrealistic to expect to obtain an hourly census, and such
data would only provide information about a certain point in time.
The nurse is counseling a healthy 30-year-old female client regarding osteoporosis
prevention. Which activity would be most beneficial in achieving the client's goal of
osteoporosis prevention?
A) Cross-country skiing
B) Scuba diving
C) Horseback riding
D) Kayaking - Correct Answer-Cross-country skiing
Rationale: Weight-bearing exercise is an important measure to reduce the risk of
osteoporosis. Of the activities listed, cross-country skiing includes the most weight-
bearing, whereas options B, C, and D involve less.
Which condition should the nurse anticipate as a potential problem in a female client
with a neurogenic bladder?
A) Stress incontinence
B) infection
, C) Painless gross hematuria
D) Peritonitis - Correct Answer-Infection
Rationale: Infection is the major complication resulting from stasis of urine and
subsequent catheterization. Option A is the involuntary loss of urine through an
intact urethra as a result of a sudden increase in intra-abdominal pressure. Option C
is the most common symptom of bladder cancer. Option D is the most common and
serious complication of peritoneal dialysis.
A client is being discharged following radioactive seed implantation for prostate cancer.
What is the most important information that the nurse should provide to this client's
family?
A) Follow exposure precautions.
B) Encourage regular meals.
C) Collect all urine.
D) Avoid touching the client. - Correct Answer-Follow exposure precautions
Rationale: Clients being treated for prostate cancer with radioactive seed implants
should be instructed regarding the amount of time and distance needed to prevent
excessive exposure that would pose a hazard to others. Option B is a good
suggestion to promote adequate nutrition but is not as important as option A. Option
C is unnecessary. Contact with the client is permitted but should be brief to limit
radiation exposure.
In assessing a client with an arteriovenous (AV) shunt who is scheduled for dialysis
today, the nurse notes the absence of a thrill or bruit at the shunt site. What action
should the nurse take?
A) Advise the client that the shunt is intact and ready for dialysis as scheduled.
B) Encourage the client to keep the shunt site elevated above the level of the heart.
C) Notify the healthcare provider of the findings immediately.
D) Flush the site at least once with a heparinized saline solution. - Correct Answer-
Notify the healthcare provider of the findings immediately.
Rationale: Absence of a thrill or bruit indicates that the shunt may be obstructed. The
nurse should notify the healthcare provider so that intervention can be initiated to
restore function of the shunt. Option A is incorrect. Option B will not resolve the
obstruction. An AV shunt is internal and cannot be flushed without access using
special needles.
, The nurse notes that the client's drainage has decreased from 50 to 5 mL/hr 12 hours
after chest tube insertion for hemothorax. What is the best initial action for the nurse to
take?
A) Document this expected decrease in drainage.
B) Clamp the chest tube while assessing for air leaks.
C) Milk the tube to remove any excessive blood clot buildup.
D) Assess for kinks or dependent loops in the tubing. - Correct Answer-Assess for
kinks or dependent loops in the tubing.
Rationale: The least invasive nursing action should be performed first to determine
why the drainage has diminished. Option A is completed after assessing for any
problems causing the decrease in drainage. Option B is no longer considered
standard protocol because the increase in pressure may be harmful to the client.
Option C is an appropriate nursing action after the tube has been assessed for kinks
or dependent loops.
The nurse is assessing a 75-year-old client for symptoms of hyperglycemia. Which
symptom of hyperglycemia is an older adult most likely to exhibit?
A) Polyuria
B) polydipsia
C) Weight loss
D) Infection - Correct Answer-Infection
Rationale: Signs and symptoms of hyperglycemia in older adults may include
fatigue, infection, and evidence of neuropathy (e.g. sensory changes). The nurse
needs to remember that classic signs and symptoms of hyperglycemia, such as
options A, B, and C and polyphagia, may be absent in older adults.
Which abnormal laboratory finding indicates that a client with diabetes needs further
evaluation for diabetic nephropathy?
A) Hypokalemia
B) microalbuminuria
C) Elevated serum lipid levels
D) Ketonuria - Correct Answer-Microalbuminuria
Rationale: Microalbuminuria is the earliest sign of diabetic nephropathy and
indicates the need for follow-up evaluation. Hyperkalemia, not option A, is
associated with end-stage renal disease caused by diabetic nephropathy. Option C
may be elevated in end-stage renal disease. Option D may signal the onset of
diabetic ketoacidosis (DKA).
